Family History Check for Hereditary Cancer
Tick what applies to you and your relatives and see whether you meet the criteria European and US guidelines use for a referral to genetic counselling for hereditary breast, ovarian, bowel, prostate and pancreatic cancer.
This check lists the situations in which guidelines recommend a referral to a genetics service. It does not test for anything, and meeting a criterion does not mean you carry a gene change: most people who are referred do not. Not meeting one does not mean zero risk either.
Talk to your oncology team, GP or a registered dietitian before acting on any number here. They know your history; a calculator does not.
Check your family history
Tick every statement that is true. Relatives means blood relatives, one side of the family at a time (your mother’s side, then your father’s). First-degree means a parent, brother, sister or child; second-degree means a grandparent, aunt, uncle, niece, nephew or half-sibling.
Tick what applies, then press the button.
How this is calculated
Strong items are situations that meet referral criteria in the NICE guideline on familial breast cancer, the NCCN criteria for hereditary breast, ovarian, pancreatic and prostate cancer, or the Amsterdam and Bethesda criteria for Lynch syndrome as used by ESMO and NICE. Moderate items are situations guidelines say are worth a conversation but do not on their own trigger a referral.
Criteria differ slightly between countries and are updated regularly; your national genetics service applies its own version. This check errs on the side of suggesting a conversation.
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How much cancer is inherited
Between 5 and 10 percent of cancers are linked to a gene change passed down in a family. The rest arise from changes that accumulate during life. Having several relatives with cancer is common simply because cancer is common, especially in a large or long-lived family; what makes a genetics service take notice is the pattern: cancers at unusually young ages, the same or related cancers in several generations, rare cancers such as male breast or ovarian cancer, or more than one primary cancer in the same person.
That is why every item in this check is about age, number and type, not about whether anyone in your family has had cancer at all.
The genes most often involved
- BRCA1 and BRCA2: breast, ovarian, prostate and pancreatic cancer, and male breast cancer. PALB2, CHEK2 and ATM carry smaller breast cancer risks.
- Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2, EPCAM): colorectal and endometrial cancer, also ovarian, stomach, small bowel and urinary tract cancers; the most common hereditary cancer syndrome.
- APC and MUTYH: bowel polyposis with a very high colorectal cancer risk.
- TP53 (Li-Fraumeni), PTEN (Cowden), CDH1 (hereditary diffuse gastric cancer) and CDKN2A (melanoma and pancreatic cancer): rarer, with distinctive family patterns.
Modern testing usually looks at a panel of these genes at once. Most people tested are found not to carry a harmful change, and a proportion receive a variant of uncertain significance, which the counsellor will explain does not change care.
What a genetics referral involves
The first appointment is a conversation, not a blood test. A genetic counsellor or clinical geneticist draws your family tree, may ask for confirmation of relatives’ diagnoses, and estimates your risk with a formal model. If testing is appropriate, they explain what the result could mean for you and for relatives, and you decide whether to go ahead. Where possible, the relative who had cancer is tested first, because a negative result in an unaffected person is only informative if the family’s gene change is already known.
Results take weeks to a few months. Counselling continues afterwards, whatever the result. In most EU countries the whole pathway is free at the point of use when referral criteria are met; waiting times vary.
What a result changes
A confirmed harmful variant opens options that are not available on family history alone: earlier and more sensitive screening (annual MRI for BRCA carriers, colonoscopy every one to two years for Lynch syndrome), risk-reducing surgery or medicines, and for people who already have cancer, targeted treatments such as PARP inhibitors or immunotherapy. Relatives can then be offered a test for that specific change, which is simple and definitive.
A negative result in a family with a known variant is genuinely reassuring: your risk returns to that of the general population and standard screening applies. A negative result in a family without a known variant does not rule out an inherited cause; screening is then based on the family history itself.
Your rights in the EU
Genetic data are a special category of personal data under the GDPR, with strict limits on who may process them and why. Several member states, including France, Germany, Austria and Belgium, also have laws restricting insurers’ and employers’ use of genetic information, and the Council of Europe’s Oviedo Convention prohibits genetic discrimination; the details differ by country, so ask the genetics service how results are stored and shared where you live.
Counselling before and after testing is standard practice in European genetics services and is part of what the referral gives you. If your country has long waiting times, the EU directive on patients’ rights in cross-border healthcare lets you seek care in another member state with prior authorisation from your insurer.
Questions to ask
Bring the result with you and ask:
- Does my family history meet the referral criteria used in this country?
- Which relative would you test first, and what would a result mean for the others?
- What screening should I have now, before any result is back?
- How long is the wait for genetic counselling, and is there an alternative route?
- How will my genetic information be stored and who can see it?
Sources and review
Written by the Beat Cancer EU editorial team using the primary sources below, which are also the formulas this tool implements. Last reviewed: September 14, 2026.
- NICE — Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer (CG164)
- NCCN — Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate
- Stjepanovic N et al. Hereditary gastrointestinal cancers: ESMO Clinical Practice Guidelines. Ann Oncol 2019 (PubMed)
- Sessa C et al. Risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes: ESMO Clinical Practice Guideline. Ann Oncol 2023 (PubMed)
- Umar A et al. Revised Bethesda Guidelines for hereditary nonpolyposis colorectal cancer (Lynch syndrome). J Natl Cancer Inst 2004 (PubMed)
- NICE — Molecular testing strategies for Lynch syndrome in people with colorectal cancer (DG27)
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